The goal of this 3-year project is to control the spread of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Chicago's Cook County Jail. CA-MRSA is a bacterium which is spreading rapidly through healthy populations, becoming an epidemic in many regions of the country. MRSA causes infections which are difficult and expensive to control because penicillins and similar drugs cannot be used to treat them. Many people in the community are asymptomatically colonized by MRSA. There have been outbreaks of MRSA infections at prisons and jails in the U.S, and they are common at the Cook County Jail. We fear that jails may be sites of rapid MRSA dissemination, in part because CA-MRSA is becoming endemic to the inner city of Chicago. We will study the spread of MRSA in the jail to better understand how the bacteria are transmitted from person to person there and how we can prevent their transmission. All detainees asked to participate must give informed consent to do so; their privacy will be carefully protected. Seventeen objects and surfaces in the jail will first be sampled for contamination with MRSA. We will test the efficacy of 3 disinfectants to decontaminate the 2 most commonly contaminated surfaces or objects that we identify. In addition, cultures will be collected from all patients with bacterial skin infections for 18 months in a part of the jail in order to determine how frequently these infections are caused by MRSA relative to other bacteria. A group of 2128 maximum-security adult detainees will be tested for colonization with MRSA in order to determine how commonly detainees carry the bacterium. A cluster-randomized 6-month study will be undertaken among these detainees to determine if chlorhexidine-containing disposable cloths for skin cleaning can be used to decrease the rate of MRSA transmission, colonization, and infection. All of the MRSA isolates and a sample of the S. aureus isolates susceptible to methicillin from specimens colonizing or infecting detainees, as well as those contaminating surfaces and objects in the jail will be tested genetically in order to determine which strains of MRSA are present in the jail. The jail-related strains will be compared with strains causing MRSA infection in the community. This study may identify important ways to stop the spread of MRSA among healthy people in jails and prisons, as well as other places. We hope that the Cook County jail will become a model jail for the control of MRSA and other resistant bacteria. [unreadable] [unreadable] [unreadable]